Systolic Ejection Murmur in a Case of Patent Ductus Arteriosus and Pulmonary Hypertension With Liver Cirrhosis

Patent ductus arteriosus (PDA) is a congenital anomaly characterized by a persistent connection between the descending aorta and the pulmonary artery. While patients with PDA typically present with a continuous murmur, atypical cases, such as those with systolic murmurs or no murmurs (although the exact mechanism remains unclear), pose diagnostic challenges. We report a case of a 38-year-old woman with alcoholic liver cirrhosis, referred for liver transplantation, in whom a systolic ejection murmur prompted further evaluation. Diagnostic imaging and right heart catheterization confirmed PDA with mild pulmonary hypertension, without evidence of Eisenmenger physiology. This case underscores the importance of recognizing atypical murmur patterns in the diagnosis of PDA to avoid misdiagnosis or delayed diagnosis.